Using a combination of biology and social constructionist epistemology the current literature and practice in the treatment of children and young people who present as gender variant or transgender has been explored and presented here is a brief overview of some of the most important points. The NHS and private medical pathways available to transgender people are very different and there are advantages and disadvantages of each pathway. The end of this article includes some advice that may be useful to parents based on information from the literature.
If a person is transgender they are commonly described as feeling as though they are trapped in the wrong body. Teich provides a simple and comprehensive explanation of what it is to be transgender in ‘Transgender 101’.
A child starts to understand their own identity by around the age of three. We also know that their identity is not fully formed until well into puberty and beyond. If a child who feels they may be transgender begins their natural puberty, the likelihood is that they will become comfortable in their natural body. However, for the small number of children who will grow up to be transgender adults, puberty can be very distressing and the mental health implications contribute to the shocking suicide statistics for transgender youth. So when, if ever, is it right to intervene? And when is it ok to wait and see?
A scientific method of differentiating between individuals who will experience transient gender dysphoria, and those who will grow up to be transgender adults, could be very useful in identifying the appropriate course of action. A physiological marker for a transgender identity would allow for this differentiation. The following research indicates that these markers may exist and that in the future we might be able to identify and confirm someone’s future gender identity.
Certain areas of the brain are responsible for a person’s feelings of belonging to their body. One small study using eight female-to-male volunteers found that their bodies registered touch, and a feeling of belonging, less strongly when their breasts were touched than their hands (as compared to eight cis-gender females). Magnetoencephalography imaging monitored the individual’s brain activity whilst “participants were tapped on the hand or the breast” (2). The results showed that for trans individuals, the area of the brain that registers touch (the second somatosensory cortex) showed less activity when the breast was touched compared to the hand. There was also less brain activity in the supramarginal gyrus which is the area associated with a feeling of ownership of one’s body. This makes sense since we know that transgender people often feel as though their body does not belong to them.
Another study investigated the ways that prepubertal and adolescent boys and girls with “gender dysphoria responded to androstadiene” (1) which is a pheromone type odour which produces a different response in cis-gender males and females. This chemical produces a different hypothalamic activation response in adult, heterosexual, cis-gender males and females which can be detected with a brain scan. The results showed that “adolescent boys and girls with gender dysphoria responded much like peers of their experienced gender. The results were less clear with the prepubertal children” (1). This indicates that prepubertal gender dysphoria is not as easy to identify and may not persist into adulthood.
The advantages of identifying whether there are physiological markers for being transgender are obvious. It would be extremely helpful in making decisions about if, when, and how, to intervene in individual cases. For a child who is going to grow up to be trans, hormone blockers could be used from an early age to block puberty. This makes any later medical transitions and surgeries easier because secondary sex characteristics will not have developed. On the other hand, for those children who will not grow up to be trans, there will be a ‘light at the end of the tunnel’ as they will know that whilst puberty is challenging, they will feel differently about their gender identity at the end of it. Early identification of long and short-term gender dysphoria may allow mental health issues and other conditions to be factored in or ruled. This is important because some of these conditions can affect a person’s feelings of identity and contribute to gender dysphoria.
There is a downside to focusing on the physiology of gender dysphoria. Looking for the ‘cause’ of this identity may lead to an attempt to ‘cure it’ and may encourage the view that this is an illness or mental health issue. This has happened in the past in the gay community where there have been attempts to ‘cure’ or ‘convert’ individuals with indoctrination groups. There is a real fear in the LGBTQ+ community that this may reoccur.
So, for now, if and until these identifiers are found, perhaps it is best to leave this medical speculating to one side and consider briefly some useful tips for anyone who finds themselves approached by a child who feels they may be trans. If this is you, what can you do?
- Keep calm: If this child is persistent and insistent that they are transgender, but you are not convinced, then consider exploring the use of hormone blockers. This medication interrupts hormone production and allows children some breathing space to explore their identity and conclude who they are. The effects are completely reversible, so if your child changes their mind later, they will grow up normally in their natal sex. However, it is important to stress that blocking hormones too early can make it difficult to ‘grow out’ of these feelings (for children who will not naturally continue to be trans) so it is really important to obtain expert medical advice from several different parties. There are huge variations in opinion in the medical community so cross-referencing different opinions is important to ensure your child is getting the right help.
- Don’t let them panic: This young person has a lot to think about, and chances are it isn’t a surprise to them like it is to you. They have been thinking about this for a long time and it’s taken a lot for them to tell you. It is your job to be supportive but also try to gently explain that during early adolescence many children feel uneasy with their bodies and go through a minor identity crisis as they struggle with their gender, sexuality, and beliefs. Along with this is sometimes a degree of gender variance or gender dysphoria. In some cases, this is mistakenly assumed to indicate a transgender identity.
- Do your research: The choice to pursue expensive private healthcare may be dangerous since the financial incentives may influence the practitioner’s choice of treatment. Comparatively, on the NHS, there are strict guidelines as to the age of medical intervention and progress can be very slow. Equally, in some cases, mental health conditions, puberty, hormones, and other factors and not gender identity are the root of the gender dysphoria. There is so much to learn before you start making any big decisions, but it is also important to speak to your child directly about what they want- chances are they’ve got a pretty clear idea and they’ll be able to teach you a thing or two!
- Don’t’ decide for them: You should be aware that the likelihood of your child being transgender is very slight and that if they feel this is something that you want them to be, this could influence their choices. However, if they are transgender, then ignoring this can have devastating effects. It’s important that children not be categorised and labelled as a result of their choice of play or clothing. Perhaps a girl who enjoys wearing boys’ clothes, playing football, and getting muddy, is told that she may be transgender and in fact a boy; whilst this may be the case, statistically, it is vastly more likely that she is simply a tomboy. Remember, labels are internalised and can have a big effect, so concentrate on positive support.
Most importantly you should remember that you are not alone! You are not the first adult to hear this from a child, and you won’t be the last. It is a great thing that this child has felt comfortable enough to share their troubles with you and no doubt it has taken a great deal of courage to seek help. However, chances are that you are not fully equipped to give this help alone. If you need any advice there are many support groups, children’s charities and professional agencies that will help you, not forgetting your GP. Remember that if your child is transgender, you will have the pleasure of watching them become who they truly feel they are, right before your very eyes. How much luckier can you get?
References and Further Reading
(1) Russo, F. (2016) Is There Something Unique about the Transgender Brain?
(2) Thomson, H. (2016) Brain scans show trans people feeling at odds with their body.
(3) Teich, N. (2012) Transgender 101: A Simple Guide to a Complex Issue.
Annabel Watson is a Ph.D. researcher investigating why children go into the care system and whether the system can be improved. She studied transgender youth for her undergraduate dissertation Her research interests are largely focused on equality and reducing poverty.